Provider Demographics
NPI:1912904855
Name:CALDERON, ERICK E (MD, FACC)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:E
Last Name:CALDERON
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:MS
Other - First Name:JOYCE
Other - Middle Name:G
Other - Last Name:SEWALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ADMINISTRATOR
Mailing Address - Street 1:6310 HEALTH PARK WAY
Mailing Address - Street 2:SUITE 230
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5177
Mailing Address - Country:US
Mailing Address - Phone:941-907-1113
Mailing Address - Fax:940-907-3887
Practice Address - Street 1:6310 HEALTH PARK WAY
Practice Address - Street 2:SUITE 230
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5177
Practice Address - Country:US
Practice Address - Phone:941-907-1113
Practice Address - Fax:940-907-3887
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77684174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL257646500Medicaid
FL257646500Medicaid
FLG29735Medicare UPIN